Salt, starch, and water on the brain.

Isotonic fluids have been thoroughly studied and for the vast majority of neurosurgical patients are both safe and effective. Conversely, HS may have some transient beneficial effects on cerebral physiology in animal models of brain injury. However, further studies are needed to measure the functional outcome rather than early parameters of CNS function with HS resuscitation. In addition, HS has a defined risk. Until the risk-benefit ratio of HS is better defined in humans, physicians should exercise caution and adhere to the Hippocratic oath. However, if this risk-benefit ratio is defined, HS may hold promise for the clinical conditions cited herein as well as other novel uses (cardiopulmonary bypass, spinal trauma [55,56]).